肝叶切除术联合胆肠吻合术及肝外胆道切除术治疗肝门部胆管癌患者的临床研究

Clinical Study of Hepatectomy Combined with Cholangioenterostomy and Extrahepatic Biliary Resection for Hepatic Hilar Cholangiocarcinoma

目的探讨肝叶切除术联合胆肠吻合术及肝外胆道切除术在肝门部胆管癌(HCCA)治疗中的临床价值。方法按照手术方案将76例HCCA患者分为观察组与对照组,每组38例,对照组行常规肝外胆道切除术联合胆肠吻合术,观察组在此基础上再行肝叶切除术。对比两组手术及术后康复情况、并发症发生率、手术前及术后1个月生存质量(QLQ-30评分)改善情况,术后随访2年,统计对比两组1年生存率、2年生存率。结果手术及术后恢复情况:观察组手术时间长于对照组(P<0.05),但术中出血量、住院时间与对照组比较无显著差异(P>0.05);并发症:观察组术后并发症发生率[23.68%(9/38)]与对照组[18.42%(7/38)]比较无显著差异(P>0.05);生存质量:术后1个月,两组躯体功能、情绪功能及社会功能评分均较术前增加,且观察组高于对照组(P均<0.05);生存状况:术后随访2年,两组均无失访病例,随访率均为100.0%(38/38);观察组1年生存率为68.42%(26/38)、2年生存率为50.0%(19/38),与对照组[55.26%(21/38)和34.21%(13/38)]比较无显著差异(P>0.05)。结论肝叶切除术联合胆肠吻合术及肝外胆道切除术治疗HCCA,虽导致手术时间延长,但不会增加术中出血及术后并发症发生风险,且有利于改善患者生存质量,但尚无有效数据证实该联合手术方案可有效提高HCCA患者生存率。

Objective To investigate the clinical value of hepatectomy combined with cholangioenterostomy and extrahepatic biliary resection in the treatment of hilar cholangiocarcinoma(HCCA).Methods According to the surgical plan,76 patients with HCCA were divided into the observation group and the control group,38 cases in each group.The control group underwent routine extrahepatic biliary resection combined with cholangioenterostomy.On the basis of this,the observation group performed hepatectomy.The improvement of operation and postoperative rehabilitation,incidence of complications,quality of life(QLQ-30 score)before operation and 1 month after operation were compared between the two groups.The postoperative follow-up was performed for 2 years,and the 1-year survival rate and 2-year survival rate of the two groups were statistically compared.Results Surgery and postoperative recovery:The operation time of the observation group was longer than that of the control group(P<0.05),but the intraoperative blood loss and hospitalization time were not significantly different from the control group(P>0.05).Complications:There was no significant difference in the incidence of postoperative complications between the observation group[23.68%(9/38)]and the control group[18.42%(7/38)](P>0.05).Quality of life:1 month after operation,the scores of physical function,emotional function and social function in the two groups increased compared with that before operation,and the observation group was higher than the control group(P<0.05).Survival status:After 2 years of follow-up,there were no cases lost to follow-up in both groups,the follow-up rate was both[100.0%(38/38)].There was no significant difference in 1-year survival rate[68.42%(26/38)]and 2-year survival rate[50.0%(19/38)]between the observation group and the control group[55.26%(21/38)and 34.21%(13/38)](P>0.05).Conclusion Hepatectomy combined with cholangioenterostomy and extrahepatic biliary resection for the treatment of HCCA,although prolonging the operation time,does not increase the risk of intraoperative bleeding and postoperative complications,and is beneficial to improve the quality of life of patients,but there is no effective data to prove that the combined surgery can effectively improve the survival rate of HCCA patients.